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Remote Monitoring Shows Significant Population
Health Benefits
Session 16, February 12, 2019
Laurie Poole, VP, Clinical Innovation, OTN (@poolelaurie)
Dr. Andrew Watson, Payer-provider physician executive, UPMC (@arwmd)
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Laurie Poole, RN, BScN, MHSA
Has no real or apparent conflicts of interest to report.
Dr. Andrew Watson, MD, MLitt., FACS
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Overview of OTN’s Remote Monitoring Program in Ontario
(Telehomecare)
• Overview of UPMC’s Remote Monitoring Program
• Questions and Discussion – projected 20 minutes
Feel free to tweet questions to @arwmd, @poolelaurie
Agenda
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• Demonstrate how UPMC and OTN utilized remote patient
monitoring to improve patient engagement and outcomes for
chronic disease management.
• Analyze the approach taken to ensure implementation of remote
care technology.
• Discuss how remote care succeeds in inspiring patient
engagement where other approaches fall short.
Learning Objectives
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OTN is a not-for-profit organization funded
by the Government of Ontario
• Far Reaching Membership
• 3,199 organizations and 26,125 healthcare providers
• Partner with Provincial & Federal Delivery Organizations
• A catalyst for the use of virtual care in Ontario
Ontario Telemedicine Network
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3,587
COPD/CHF PATIENTS
ENROLLED IN IN-HOME
MONITORING
3,151
HOSPITAL VISITS AVOIDED
BY PATIENTS ENROLLED IN
IN HOME MONITORING
$71M
EST. ANNUAL SAVINGS
TO THE HEALTHCARE SYSTEM
Results and Value at Scale
Fiscal Year 2017/8 (April 1, 2017 to March 31, 2018)
896,529
21,315
CLINICAL HOME VISITS
156,921
LEARNING EVENTS
PATIENTS SERVED
28,663
OTNHUB USERS
33,643
eCONSULTS
2 days
eCONSULT AVERAGE RESPONSE
TIME
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Chronic Disease
Management Programs
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Remote Monitoring in Canada
• Canada Health Infoway has been a
key proponent in advancing Remote
monitoring with funded initiatives in
almost all of the provinces and
territories
• Ontario’s (OTN) program is the largest
across Canada
• Since 2007, 18,000 patients with Heart
Failure or COPD have been enrolled
in OTN’s Telehomecare Program
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Ontario Telemedicine
Network
Otto and ulla video --- do we have a French captioned version?
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Fundamentals of Telehomecare Program
6 month program
for patients with
COPD or CHF
Supports
patients in their
own homes
through health
coaching and
monitoring
Derived from
evidence based
guidelines and
annually
reviewed
Delivered by
clinicians with
training in self-
management
support and
health coaching
Complementary
to the care
provided by the
most responsible
provider (MRP)
Engages &
empowers the
patient to better
manage their
health
independently
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Telehomecare Governance
Ontario Ministry
of Health
• Funding
• Health system
alignment
• Benefits evaluation
OTN
LHIN (Health Regions)
• Health system alignment
• Sustainable funding
• Oversight
• Health system integration
Host Organization
• Coach & monitor patients
• Liaises with Circle of Care
• Engagement & adoption
• Change Management
• Project management
• Training & support
• Quality improvement
• Engagement & adoption
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Telehomecare Outcomes
64%
67%
81%
58% 58%
73%
CW LHIN TC LHIN Central LHIN
Reduction in hospital admission and
emergency department visits
Hospital Admission Emergency Department
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Successes and Challenges
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UPMC
• 5 million citizens
• $20B Global company
• Primary and subspecialty
• Population health system
@arwmd
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• Telemedicine is a critical piece of population health
• UPMC designed a remote monitoring platform and integrated it –
to serve diverse needs
• We are seeing positive early results with CHF and post-partum
hypertension (mortality and pop-health measures)
Overview
@arwmd
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UPMC Dynamic Model – Population Health
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Delivery
Hospitals
Physicians / Nurses
Payment
Care management
Wellness / prevention
Value
Innovation Telemedicine
@arwmd
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Three Domains of Telemedicine
Synchrono
us Live
video to
cell phones
ASYNCHRONOUS
RPM (INBOUND
DATA)
Traditional
Rural
clinics,
emergent
@arwmd
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Remote Monitoring Continuum
• Multiple approaches to connect with patients / members
• Different methods and goals for program usage
• Pop health at scale is cost control
• Ease of use
BYOD
Tablet
Full Kit
+ Tablet
@arwmd
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RPM design ”Platform as a service”
OPERATIONS
Centralized / scalable
Kit logistics / DME
Legal / Marketing
CALL CENTER
Inbound filter
Manage alerts
HARDWARE
BYOD, tablet,
peripherals
IT INTEGRATION
Vivify portal documentation
Alerts / notes into message router
Epic, HPN, Cerner, dB, McKesson
BYOD and reporting
@arwmd
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• Defined clinical needs
– Value driven areas
• Business need
• 3 approaches to RPM
– Clinical need to business
– Business request
– ($$ and reverse engineer a
RPM program)
• Growth areas – payer, specialty
pharmacy, readmissions, HTN
• Kits / Peripherals
– CHF
• Tablet only
– AIC (also has BYOD)
– COPD
• BYOD
– AIC, PCORI, GDM
– PP HTN, CPS
– Hospice, ALS
Clinical Work – Population Health
@arwmd
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• Defined clinical needs
– Value driven areas
• Business need
• 3 approaches to RPM
– Clinical need to business
– Business request
– ($$ and reverse engineer a
RPM program)
• Growth areas – payer, specialty
pharmacy, readmissions, HTN
• Kits / Peripherals
– CHF
• Tablet only
– AIC (also has BYOD)
– COPD
• BYOD
– AIC, PCORI, GDM
– PP HTN, CPS
– Hospice, ALS
Clinical Work – Population Health
@arwmd
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• Nationally #1 cause of PP Readmissions (50%)
• Leading global cause of maternal and perinatal
mortality
– 2-8% Preeclampsia
– 16% of maternal deaths related to HTN in pregnancy
• Increasing prevalence: Obesity epidemic
• Strong predictor of CV health issues later:
– HTN, DM, hyperlipidemia – CV problems
Post-partum hypertension intro
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@arwmd
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Clinical Outcomes – CHF and PP HTN
Congestive Heart Failure – our UPMC cohort is very sick
- Tracking ED, Obs, Readmissions, Unplanned care, mortality
- 2/3 UPMC insurance ( = population health)
- approximately 2,000 patients / members
- > 92% satisfaction, average age 72, recommend to others 95%
PP HTN
- for 6w after discharge
- 54% did not need a 1w office follow-up visit (canceled)
- 93% came to 4-6w PP check (pre baseline was 50%)
- 76% UPMC HP
- 14% to ER or readmitted (1/3 non-BP issues)
@arwmd
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• RPM platform (PAAS) design is an art, as is the monitoring itself
– Very early industry
• Business model is not perfect – BUT THERE!
– Clinical to value or value (money) to clinical
– Hospital impact is an issue
• RPM is a critical pop health tool of the near future
– Recall early laparoscopy
– Medical homes / payer LOB
Implications
@arwmd
